Gender differences in 1-year clinical characteristics and outcomes after stroke: results from the China National Stroke Registry

Zhan Wang, Jingjing Li, Chunxue Wang, Xiaomei Yao, Xingquan Zhao, Yilong Wang, Hao Li, Gaifen Liu, Anxin Wang, Yongjun Wang, Zhan Wang, Jingjing Li, Chunxue Wang, Xiaomei Yao, Xingquan Zhao, Yilong Wang, Hao Li, Gaifen Liu, Anxin Wang, Yongjun Wang

Abstract

Background: Previous reports have shown inconsistent results on clinical outcomes between women and men after stroke, and little is known about gender differences on outcomes in Chinese post-stroke patients. The aim of this study was to explore whether there were gender differences on clinical characteristics and outcomes in Chinese patients after ischemic stroke by using the data from the China National Stroke Registry (CNSR).

Methods and findings: Out of 12,415 consecutively recruited patients with acute ischemic stroke in the CNSR from 2007 to 2008, 11,560 (93.1%) patients were followed up for 12 months. Their clinical characteristics and outcomes on death, recurrence, and dependency were recorded. The multivariate logistic regression was performed to determine whether there were gender differences in these outcomes. Women were older than men at baseline (67.9 vs. 64.0 years, P<0.001). Women had a higher mortality, recurrence rate, and dependency rate at 3, 6, and 12 months than men, but after adjusting for age, history of diabetes, pre-stroke dependency, stroke severity, in-hospital complications, and other confounders, there were no statistically significant differences in gender on mortality and recurrence rate at 3, 6, and 12 months; and dependency rate at 3, and 6 months. However, the dependency rate at 12 months remained significantly higher in women (odds ratio, 1.24; 95% confidence interval, 1.06 to 1.45).

Conclusions: There are many differences in clinical characteristics between women and men after ischemic stroke in China. Compared with men, women are more dependent at 12 months after stroke. This difference still exists after controlling the potential confounders.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow diagram of participants.
Figure 1. Flow diagram of participants.

References

    1. Johnston SC, Mendis S, Mathers CD (2009) Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 8: 345–354.
    1. Chen Z (Peking Union Medical College Press of China, Beijing,2008) Report of the third national death cause retrospective investigation.
    1. Petrea RE, Beiser AS, Seshadri S, Kelly-Hayes M, Kase CS, et al. (2009) Gender Differences in Stroke Incidence and Poststroke Disability in the Framingham Heart Study. Stroke 40: 1032–1037.
    1. Lewsey JD, Gillies M, Jhund PS, Chalmers JWT, Redpath A, et al. (2009) Sex Differences in Incidence, Mortality, and Survival in Individuals With Stroke in Scotland, 1986 to 2005. Stroke 40: 1038–1043.
    1. Turaj W, Slowik A, Wnuk M, Szczudlik A (2009) Gender-Related Differences in Diagnostic Evaluation and Outcome of Ischemic Stroke in Poland. Stroke 40: 980–982.
    1. Eriksson M, Glader EL, Norrving B, Terent A, Stegmayr B (2008) Sex Differences in Stroke Care and Outcome in the Swedish National Quality Register for Stroke Care. Stroke 40: 909–914.
    1. Reid JM, Dai D, Gubitz GJ, Kapral MK, Christian C, et al. (2008) Gender differences in stroke examined in a 10-year cohort of patients admitted to a Canadian teaching hospital. Stroke 39: 1090–1095.
    1. Roquer J, Campello AR, Gomis M (2003) Sex differences in first-ever acute stroke. Stroke 34: 1581–1585.
    1. Kapral MK, Fang J, Hill MD, Silver F, Richards J, et al. (2005) Sex differences in stroke care and outcomes: results from the Registry of the Canadian Stroke Network. Stroke 36: 809–814.
    1. Sheikh K, Bullock CM (2007) Effect of measurement on sex difference in stroke mortality. Stroke 38: 1085–1087.
    1. Holroyd-Leduc JM, Kapral MK, Austin PC, Tu JV (2000) Sex differences and similarities in the management and outcome of stroke patients. Stroke 31: 1833–1837.
    1. Benatru I, Rouaud O, Durier J, Contegal F, Couvreur G, et al. (2006) Stable stroke incidence rates but improved case-fatality in Dijon, France, from 1985 to 2004. Stroke 37: 1674–1679.
    1. Kong F-Y, Tao W-D, Hao Z-L, Liu M (2010) Predictors of One-Year Disability and Death in Chinese Hospitalized Women after Ischemic Stroke. Cerebrovascular Diseases 29: 255–262.
    1. Wang Y, Cui L, Ji X, Dong Q, Zeng J, et al. (2011) The China National Stroke Registry for patients with acute cerebrovascular events: design, rationale, and baseline patient characteristics. Int J Stroke 6: 355–361.
    1. Stroke–1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke 20: 1407–1431.
    1. Dong K (2009) Medical insurance system evolution in China. China Econ Rev 20: 591–597.
    1. Liu Y (2004) Development of the rural health insurance system in China. Health Policy Plan 19: 159–165.
    1. Liu Y (2002) Reforming China's urban health insurance system. Health Policy Plan 60: 133–150.
    1. Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, et al. (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20: 864–870.
    1. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2: 81–84.
    1. Oh M-S, Yu K-H, Roh J-K, Lee B-C (2009) Gender Differences in the Mortality and Outcome of Stroke Patients in Korea. Cerebrovascular Diseases 28: 427–434.
    1. Niewada M, Kobayashi A, Sandercock PA, Kaminski B, Czlonkowska A (2005) Influence of gender on baseline features and clinical outcomes among 17,370 patients with confirmed ischaemic stroke in the international stroke trial. Neuroepidemiology 24: 123–128.
    1. Caso V, Paciaroni M, Agnelli G, Corea F, Ageno W, et al. (2010) Gender differences in patients with acute ischemic stroke. Womens Health (Lond Engl) 6: 51–57.
    1. Silva GS, Lima FO, Camargo EC, Smith WS, Lev MH, et al. (2010) Gender differences in outcomes after ischemic stroke: role of ischemic lesion volume and intracranial large-artery occlusion. Cerebrovasc Dis 30: 470–475.
    1. Palnum KD, Andersen G, Ingeman A, Krog BR, Bartels P, et al. (2009) Sex-Related Differences in Quality of Care and Short-Term Mortality Among Patients With Acute Stroke in Denmark: A Nationwide Follow-Up Study. Stroke 40: 1134–1139.
    1. Glader EL, Stegmayr B, Norrving B, Terent A, Hulter-Asberg K, et al. (2003) Sex differences in management and outcome after stroke: a Swedish national perspective. Stroke 34: 1970–1975.
    1. Yang ZJ, Liu J, Ge JP, Chen L, Zhao ZG, et al. (2012) Prevalence of cardiovascular disease risk factor in the Chinese population: the 2007–2008 China National Diabetes and Metabolic Disorders Study. Eur Heart J 33: 213–220.
    1. Zhang B, Pu S, Zhang W, Yang N, Shen G, et al. (2011) Sex differences in risk factors, etiology, and short-term outcome of cerebral infarction in young patients. Atherosclerosis 216: 420–425.
    1. Huang Y, Wang J-G, Wei JW, Headley AP, Wong LKS, et al. (2010) Research: Age and gender variations in the management of ischaemic stroke in China. International Journal of Stroke 5: 351–359.
    1. Palm F, Urbanek C, Wolf J, Buggle F, Kleemann T, et al. (2011) Etiology, Risk Factors and Sex Differences in Ischemic Stroke in the Ludwigshafen Stroke Study, a Population-Based Stroke Registry. Cerebrovasc Dis 33: 69–75.
    1. Kapral MK, Degani N, Hall R, Fang J, Saposnik G, et al. (2011) Gender differences in stroke care and outcomes in Ontario. Womens Health Issues 21: 171–176.
    1. Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, et al. (2003) Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke 34: 1114–1119.
    1. Gargano JW, Reeves MJ (2007) Sex differences in stroke recovery and stroke-specific quality of life: results from a statewide stroke registry. Stroke 38: 2541–2548.
    1. Saji N, Shimizu H, Kawarai T, Tadano M, Kita Y, et al. (2011) Clinical features of a first-ever lacunar infarction in Japanese patients: poor outcome in females. J Stroke Cerebrovasc Dis 20: 231–235.
    1. Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, et al. (2008) Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol 7: 915–926.
    1. Fukuda M, Kanda T, Kamide N, Akutsu T, Sakai F (2009) Gender Differences in Long-term Functional Outcome after First-ever Ischemic Stroke. Internal Medicine 48: 967–973.
    1. Jia Q, Zhao X, Wang C, Wang Y, Yan Y, et al. (2011) Diabetes and poor outcomes within 6 months after acute ischemic stroke: the China National Stroke Registry. Stroke 42: 2758–2762.
    1. Gargano JW, Wehner S, Reeves M (2008) Sex differences in acute stroke care in a statewide stroke registry. Stroke 39: 24–29.
    1. Deng YZ, Reeves MJ, Jacobs BS, Birbeck GL, Kothari RU, et al. (2006) IV tissue plasminogen activator use in acute stroke: experience from a statewide registry. Neurology 66: 306–312.
    1. Bateman BT, Schumacher HC, Boden-Albala B, Berman MF, Mohr JP, et al. (2006) Factors associated with in-hospital mortality after administration of thrombolysis in acute ischemic stroke patients: an analysis of the nationwide inpatient sample 1999 to 2002. Stroke 37: 440–446.
    1. Allen NB, Myers D, Watanabe E, Dostal J, Sama D, et al. (2009) Utilization of intravenous tissue plasminogen activator for ischemic stroke: are there sex differences? Cerebrovasc Dis 27: 254–258.

Source: PubMed

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